Infants aged 4 to 6 months can eat complementary foods to avoid iron and calcium deficiency

The issue of breastfeeding and complementary food intake has sparked different opinions in the medical community. The National Health Bureau of the Department of Health, Executive Yuan and the World Health Organization both agree that exclusive breastfeeding should last for at least 6 months. Although the Taiwan Pediatric Association expressed support, clinical experience has found that newborns who drink exclusive breast milk will develop iron deficiency anemia and vitamin D deficiency after 4 months.

Dr. Li Bingying recommends that mothers of newborns can feed complementary foods after 4 to 6 months and continue breastfeeding until 1 year old, but exclusive breastfeeding for more than 6 months is not recommended. (Photo by Zhang Shijie)

The Taiwan Pediatric Association publicly recommends that mothers of newborns can feed complementary foods after 4 to 6 months and continue breastfeeding until 1 year old, but it does not recommend exclusive breastfeeding for more than 6 months. Li Bingying, secretary general of the Taiwan Pediatric Association and associate professor of pediatrics at the National Taiwan University College of Medicine, made the above remarks regarding the timing of using infant complementary foods and nutrients at a seminar on "Infant Feeding Policy Evidence" on the morning of the 8th.

Dr. Li Bingying pointed out that humans are mammals, and breastfeeding is a natural and healthy behavior. However, due to the fact that modern women have multiple jobs and formula milk has been heavily advertised in the media in the past, breastfeeding has become something that needs to be encouraged and certified. Especially since the start of the mother-and-baby friendly certification in 2001, under this system, medical institutions began to refuse sponsorship from milk powder companies and worked hard for mother-and-baby friendly work. Last year, the birth coverage rate in medical institutions that passed the mother-child friendly certification was 71.4%, the exclusive breastfeeding rate during hospitalization was 43.6%, and the total breastfeeding rate was 96.2%.

However, overemphasizing the importance of breastfeeding may cause mothers who are unable to breastfeed due to various factors to feel mentally guilty, which may have a counterproductive effect on the implementation of the mother-child friendly policy goals. Recently, we encountered two cases in the outpatient clinic of National Taiwan University Hospital. One was a one-year-old exclusively breastfed baby boy who developed rickets due to vitamin D deficiency, and the other was a six-month-old exclusively breastfed baby girl who developed iron deficiency anemia.

Clinically, it is found that if complementary foods are not given to babies until 6 months old, they may suffer from iron and calcium deficiency, which may lead to iron deficiency anemia, affect brain nerve development and other sequelae.

Associate Professor Li Bingying pointed out that when a normal and healthy full-term baby is born, the iron stored in the body is usually sufficient for the baby's body needs for 4 to 6 months; but after exclusive breastfeeding for more than 6 months, the chance of iron deficiency anemia increases, so there are individual differences after about 6 months; but he does not recommend supplementing with iron-rich complementary foods before 4 months; but babies with insufficient iron stores at birth, such as premature babies, low birth weight babies, mothers with diabetes, etc., need to supplement iron earlier.

Clinically, it is found that if complementary foods are not given to babies until after 6 months, they may suffer from iron and calcium deficiency, which may cause iron deficiency anemia, affect brain nerve development and other sequelae. Therefore, it is recommended to supplement iron and calcium from 4 months old, and after 6 months, children can eat whatever adults eat. It is also recommended that mothers choose natural options and DIY by themselves, including meat puree, fruit puree, etc.

Because the iron in food is mainly found in red meat, sesame, seaweed, red beans, broad beans, pork liver, oysters, fish, etc., dried fruits are also one of the sources of iron. Currently, commercially available baby rice and wheat flour also have added iron. The mother's own iron supplementation from the diet has little effect on the iron content in breast milk.

In addition, there are mothers in the clinic who are worried that allergenic foods may cause allergies in their children, so they avoid feeding them too early and wait until their children grow up to eat them. Associate Professor Li Bingying believes that many foreign studies have confirmed that this is a wrong concept. Children's immune system needs to be trained. Therefore, when they are able to eat complementary foods, they can be gradually added, especially for nutrients such as vitamin D, zinc, and iron, which should be taken earlier.